G. Bagou *, B. Cabrita , P.-F. Ceccaldi , G. Comte , M. Corbillon-Soubeiran , J.-F. Diependaele , F.-X. Duchateau , O. Dupuis , V. Hamel , A. Launoy , N. Laurenceau-Nicolle , E. Menthonnex , Y. Penverne , T. Rackelboom , A. Rozenberg , C. Telion m a Samu-69, groupement hospitalier Edouard-Herriot, 3, place d’Arsonval, 69437 Lyon cedex 03, France b Samu-21, hopital general, 3, rue du Faubourg-Raines, BP 1519, 21033 Dijon cedex, France c Service de gynecologie obstetrique, hopital Beaujon, 92110 Clichy, France d Samu-Cesu-80, hopital Nord, 80054 Amiens cedex, France e Smur pediatrique, CHRU de Lille, 59037 Lille cedex, France f Smur Beaujon, hopital Beaujon, 92110 Clichy, France g Service de gynecologie obstetrique, centre hospitalier Lyon-Sud, 69495 Pierre-Benite cedex, France h Samu-44, 8, quai Moncousu, 44093 Nantes cedex 1, France i Service de reanimation chirurgicale, hopital de Hautepierre, 67098 Strasbourg cedex, France j Cellule regionale des transferts perinatals Rhone-Alpes, groupement hospitalier Edouard-Herriot, 69437 Lyon cedex 03, France k Samu-38, CHU, BP 217, 38043 Grenoble cedex 9, France l Service d’anesthesie reanimation, groupe hospitalier Cochin St-Vincent-de-Paul, 75679 Paris cedex 14, France m Samu de Paris, hopital Necker, 75743 Paris cedex 15, France

Depuis la fin des années 1970, les transports néonatals sont organisés et réalisés, en France et dans la plupart des pays européens, par des équipes spécialisées, le plus souvent médicalisées. Celles-ci sont soit dédiées et disponibles pour une région, soit liées à une unité de réanimation néonatale au sein d’un réseau local ou régional. En France, la législation a évolué permettant de définir au cours du transfert néonatal, en lien avec les changements d’organisation liés au Plan périnatalité, deux niveaux de soins et de surveillance: médicalisé et infirmier. Les Smur pédiatriques ont participé dans notre pays à la diffusion des techniques récentes et des protocoles de soins, à l’amélioration des résultats obtenus et à la mise en place de la régionalisation des soins périnatals. Ils ont également contribué à évaluer dans plusieurs régions françaises les politiques périnatales des 15 dernières années et à former les urgentistes, les pédiatres, les sages-femmes et les infirmier(ère)s.

More and more applications of artificial intelligence technologies are made in biomedical software and equipment. These applications are multiple: intelligent alarms, intelligent monitoring, diagnosis support, …. Several different knowledge representation schemes are already in use: decision trees, first-order logic expert systems, calculations (mathematical modeling), trained neural network simulations, …. All these techniques have their own preferred field of application, and they do not overlap. Building a complete diagnosis support tool would require the use of several of these techniques. The problem is therefore communication between these very different systems and the complexity of the composite result. This paper describes the Think! formalism: a unified symbolic-connectionist representation scheme which tries to subsume some of the precited formalisms. Being able to integrate these knowledge representation schemes in a single model enables us to use existing knowledge bases and existing knowledge extraction techniques to make them communicate and work together.

La minaccia di parto prematuro (MPP) si caratterizza per la combinazione di alterazioni cervicali e di contrazioni uterine regolari e dolorose che compaiono tra 22 e 36 settimane di amenorrea (SA) + 6 giorni. Benché il parto prematuro spontaneo sia spesso preceduto da una MPP, molte pazienti ricoverate per MPP non partoriscono prima delle 37 SA. L’esplorazione vaginale presenta un buon valore predittivo positivo di parto prematuro in considerazione in caso di criteri severi, ma in caso di modifiche cervicali moderate il suo valore prognostico è mediocre. L’ecografia del collo uterino eseguita per via transvaginale e/o il dosaggio della fibronectina fetale nelle secrezioni vaginali possono permettere di diminuire il numero di ricoveri e di limitare l’attuazione di terapie intensive come la tocolisi, una terapia corticosteroidea e un trasferimento in utero. La tocolisi prolunga la gravidanza riducendo la percentuale di parto a 24 ore, 48 ore e al 7° giorno. Tuttavia, i betamimetici e i calcioantagonisti sono responsabili di effetti collaterali cardiovascolari non trascurabili, che possono arrivare fino all’edema polmonare acuto (EPA). Queste due classi di molecole sono controindicate in caso di gravidanza multipla, poiché il rischio di comparsa di EPA è aumentato. L’atosiban, inibitore selettivo dell’ossitocina, deve essere utilizzato in prima intenzione in caso di gravidanza multipla e deve essere il tocolitico di riferimento in caso di trasferimento in utero. La sua assenza di effetti cardiovascolari secondari permette il trasferimento in vettore non medicalizzato. I corticosteroidi hanno un’efficacia comprovata nella maturazione polmonare fetale prima delle 34 SA. È il betametasone che deve essere utilizzato. Devono essere orientate verso una maternità tipo 3 le MPP di età gestazionale <33 SA. Al fine di evitare i trasferimenti inutili e scegliere il vettore più adatto per il trasferimento, è opportuno che siano elaborati procedure e protocolli comuni nel quadro delle reti perinatali. È auspicabile che queste chiamate siano centralizzate da una cellula regionale specifica di trasferimenti perinatali.

Objective To develop a telephone score predicting imminent delivery. Methods Prospective multicenter (n=38) study including pregnancies of 33 weeks or more amenorrhea (n=3.499). Values in points were assigned to risk factors (Cox's model) and the score tested on a validation cohort and receiver operating characteristic curves. Results Risk was increased if the caller was panicking or declared delivery to be imminent (+3 points), if the pregnant woman could not be spoken to herself (+3), was aged 26–35 (+3) years, was having frequent contractions (from +4 to +8), had the urge to push (+2 to +6 depending on starting time), had a history of rapid or home delivery (+2), or had not been followed up during pregnancy (+8). Nulliparous women (−7) or those on tocolytic treatment (−3) were less at risk. The score is reproducible and relevant. Conclusion Score predicting imminent delivery scoring during calls is a valid means of assessing risk of delivery.

Bacterial tracheitis is a severe cause of acute infectious upper-airway obstruction. Its characteristics include thick purulent secretions with or without plaques or pseudomembrane formation. Fatal complications are infrequent if an appropriate treatment is conducted.Case report. We report on 2 cases of bacterial tracheitis revealed by out-of-hospital cardiac arrest. At presentation in winter, both children first had the symptoms of viral croup. However, no response to the appropriate therapy for this disease was observed. A cardiac arrest occurred on the second day. Bronchoscopy allowed diagnosis. Findings on initial examination were erythema, edema and purulent secretions. Bacterial cultures of tracheal secretions were positive with Staphylococcus aureus. Serology with influenza A virus was also positive. Despite antibiotics and mechanical ventilation, both children died in the pediatric intensive care unit, consecutively to irreversible ischemic brain injury.Conclusion. Bacterial tracheitis remains a life-threatening upper-airway infection. Prompt recognition and accurate diagnosis could lead to decreased mortality. It is essential to reassess any croup whose outcome is not rapidly favourable. Such patients should be monitored in a pediatric intensive care unit. (C) 2008 Elsevier Masson SAS. All rights reserved.

The aim of this study was to describe the changes in strategy of revascularisation in acute coronary syndromes with ST elevation (ACS ST+) since setting up a health care network. The authors analysed the incidence of coronary angioplasty and of intravenous thrombolysis from a prospective permanent hospital register of patients with ACS ST+ in the three Northern Alps departments from october 1st 2002 to december 31st 2004. Respectively, 171 patients were enrolled in 2002 and 675 in 2003, and 588 in 2004. The use of percutaneous coronary intervention increased (57, 69, and 78% in 2002, 2003, 2004, p< 0.01) in relation to the increased use of immediate secondary percutaneous coronary intervention (27, 36, 43%, p< 0.01) although the use of primary percutaneous coronary intervention did not changed (30, 33, 35%, p= 0.17). These results were observed in hospitals with and without Percutaneous Coronary Intervention facilities. An increase in prehospital (49, 67, 68%, p= 0.02) and hospital thrombolysis (48, 68, 73%, p= 0.03) was only observed in patients managed in institutions without Percutaneous Coronary Intervention facilities. The average delay to arterial punction (120. 124, 100 minutes, p< 0.01) and to intravenous thrombolysis (40, 30, 25 minutes, p< 0.01) decreased during the same period. Patients with ACS ST+ more commonly benefit from coronary revascularisation at increasingly shorter intervals to treatment. This would seem to be related to the better coordination of practitioners after the implantation of a health care network.

PURPOSE:Study the epidemiology, prehospital emergency care and short-term evolution of the drug self poisonings.METHODS:Retrospective analysis from January 1999 to December 2000 of drug self poisonings requiring Grenoble (France) intensive care unit action and patient follow up.RESULTS:325 patients, 39.3 years old +/- 14.5 have been treated. The drug self poisonings are representing 4.6% of Grenoble mobile intensive care unit activity. The sex-ratio was, for the 15 to 24 years old population, 2.3 females for 1 male. Mobile intensive care unit has been decided in first intention on 56.3%. 556 toxic substances have been reported, psychotropics are prevailing (79.4% of all drug self poisonings). Intubation has been necessary in 24%. 64.4% of the treated population has been hospitalized into intensive care units. The main exit step of the first admission unit was returning home. Death rate was 0.9%.CONCLUSION:Drug self poisoning is an important part of mobile intensive care unit activity. The very low death rate could be related to several criteria: a high efficient rescue unit setting up a symptomatic based medical treatment and the current decreased toxicity of the ingested drugs.